Governing Body Meeting in Public

Transcription

1 Agenda Item No: Item 7 of Meeting: Thursday 30 th March 2017 Governing Body Meeting in Public Paper Title: Finance Report Month /17 Decision Discussion Information Follow up from last meeting Report author: Report signed off by: Julie Williams, Senior Finance Manager Alan Pond, Chief Finance Officer Executive Summary: This paper provides details of the finance position at the end of January. At Month 10 the year to date position is breakeven against plan. This is achieved by bringing into the figures an amount of contingency reserve to match what would otherwise be an overspend of 2,545k. This equates to 71% of the available reserve whereas we are 83% of the way through the year. The CCG continues to forecast achievement of its control total. The control total was agreed with NHS England as an underspend of 7.743m, but Governing Body members will be aware that, in common with other CCGs nationally, the CCG was also prohibited from spending a further 1% of its funding. This 6.955m has been held back in reserve and excluded from the reported financial position. NHS England has now confirmed that the funding so held back remains unavailable for spending, but is now to be brought into CCGs reported financial positions. Across all commissioners this will release 800m, which will help to offset the national provider deficit position and help to secure a balanced position for the NHS overall. With the 6.955m now to be brought into the CCG s financial position, the revised control total is an underspend of m and the forecast position is an underspend of m. Only two localities are underspent at month 10, North Herts and Stort Valley and Villages. 1

2 Recommendations to the members: To note the Month 10 position. Conflicts of Interest involved: There are no conflicts of interest 2

3 Finance Report 2016/17 CCG Governing Body Meeting 30 th March 2017 APPENDICES Appendix 1 Acute Commissioning Appendix 2 Locality Report TERMS/ACRONYMS USED IN THE REPORT Initials B&CF BEH BPPC BSA CCG CHC CUFT DOL ED FNC FYE HCT HPFT MCD MH MVCC NHSE PAH POD RTT SLAM T&O UCC UCLH In full Barnet and Chase Farm Hospital Trust Barnet, Enfield and Haringey Better payments practice code Business Services Authority Clinical Commissioning Group Continuing healthcare Cambridge University Foundation Trust Deprivation of liberty Emergency department Funded nursing care Full year effect Hertfordshire Community Trust Hertfordshire Partnership Foundation Trust Maximum cash drawdown Mental health Mount Vernon Cancer Centre NHS England Princess Alexandra Hospital Point of Delivery Referral to treatment Service Level Agreement Monitoring Trauma and Orthopaedics Urgent care centre University College London Hospitals date 3

4 1. EXECUTIVE SUMMARY VARIANCE AGAINST PLAN JANUARY 2017 Overall Position G (0) Acute contracts R (9,125) GP Prescribed Drugs R (390) Non acute commissioning and Primary Care G 5,410 Transformation reserve and investments G 1,133 Contingency reserve G 2,545 Running Costs G 426 % Utilised Contingency G 71% committed G 2,545 Invoices Value Better Payments Practice Code (BPPC) NHS 93.6% 99.2% (Target is 95% of invoices by value and number are paid within 30 days) Non-NHS 98.2% 94.6% At Month 10 the year to date position is breakeven against plan. This is achieved by bringing into the figures an amount of contingency reserve to match what would otherwise be an overspend of 2,545k. This equates to 71% of the available reserve whereas we are 83% of the way through the year. The CCG continues to forecast achievement of its control total. The control total was agreed with NHS England as an underspend of 7.743m, but Governing Body members will be aware that, in common with other CCGs nationally, the CCG was also prohibited from spending a further 1% of its funding. This 6.955m has been held back in reserve and excluded from the reported financial position. NHS England has now confirmed that the funding so held back remains unavailable for spending, but is now to be brought into CCGs reported financial positions. Across all commissioners this will release 800m, which will help to offset the national provider deficit position and help to secure a balanced position for the NHS overall. 4

5 With the 6.955m now to be brought into the CCG s financial position, the revised control total is an underspend of m and the forecast position is an underspend of m. Only two localities are underspent at month 10, North Herts and Stort Valley and Villages 2. EXPENDITURE REPORT 2.1 CCG Allocation and Budgets The CCG s allocation has increased by 350k since last month, as shown in the table below. All of the funds received are committed and therefore will not benefit our bottom-line position. Month 10 Allocation at month 9 722,526 New allocations: GP Access Winter Presssures 253 Funding Transfer for IUC Evaluation Pilots 97 Total notified allocation 722, CCG Overall Position At Month 10 the year to date position is breakeven against plan. This is achieved by bringing into the figures 2,545 contingency reserve. A summary of the position is shown below. POSITION AS AT 31st JANUARY 2017 Description Annual budget budget Actual FOT Previous month extrapolated Movement Allocation 722,876 Budget Heading Acute Commissioning 393, , ,952 (9,125) (10,881) (7,512) (1,613) Non Acute Commissioning 195, , ,769 3,804 4,258 3, GP Prescribed Drugs 79,688 66,771 67,160 (390) (465) 81 (471) Other Primary Care 18,956 15,796 14,190 1,606 1,651 1,634 (28) Running Costs 12,455 10,378 9, (19) Transformation reserve 6,955 6,955 Contingency reserve 3,580 2,545 2,545 3,580 1,340 1,205 Quality Premium Resilience funding 4,036 3,801 3, Total in year position 715, , ,487 (0) 6,955 (0) (0) TOTAL UNDER/(OVER) SPEND 7,743 14,698 5

6 2.3 Locality Positions The table below shows the Month 10 locality positions. FINANCE REPORT - LOCALITY SUMMARY POSITION AS AT 31st JANUARY 2017 Description Allocation year to date Actual Previous month extrapolated Movement North Herts 111, , (209) Lower Lea Valley 75,063 75,235 (172) 37 (209) Stevenage 90,748 91,299 (551) (533) (18) Welhat 106, ,068 (439) (520) 81 Upper Lea Valley 109, ,568 (102) (665) 562 Stort Valley & Villages 52,842 52, (89) Reserves & Unattributable 42,898 41,760 1,138 1,258 (120) Total 589, ,487 (0) 0 (0) TOTAL UNDER/(OVER) SPEND 7,743 Currently only two localities are underspent, North Herts and Stort Valley and Villages. In month 9 Upper Lea Valley saw a big increase in spend which has been reversed in month 10, reflecting problems with data at PAH. Lower Lea Valley has moved into an overspend position, mainly due to an increase in the cost of non-elective activity this month. 2.4 Commissioning Acute Financial Performance COMMISSIONING - ACUTE POSITION AS AT 31st JANUARY 2017 Description Annual budget budget Actual FOT Previous month extrapolated Movement East and North Herts Trust 206, , ,479 (9,156) (10,240) (8,138) (1,019) Princess Alexandra Hospital 57,161 47,634 47,779 (145) (193) (185) 40 Royal Free FT 25,635 21,362 21,967 (605) (726) (670) 65 Independent Sector 23,381 19,484 20,841 (1,357) (1,628) (1,074) (283) Cambridge University Hospitals 11,394 9,495 9, Other Acute 69,016 57,529 55,558 1,971 1,706 2,509 (538) 0 0 TOTAL 393, , ,952 (9,125) (10,881) (7,512) (1,613) 6

7 East and North Hertfordshire NHS Trust At month 10, East and North Hertfordshire NHS Trust (ENHT) is showing an over performance of 9,156k. The key areas of over performance continue to be A&E, non-elective, day cases and outpatients. There have been some noticeable improvements in ENHT s position compared to the forecast at month 9. Specifically, there has been a 220k improvement in the inpatient elective position and 107k improvement in maternity. The reduction in inpatient elective activity is a reflection of the pressures at ENHT during the Christmas and New Year period, which led to a significant reduction in elective activity undertaken during January In addition, antenatal pathways are current 5% under plan for both activity and finance and 7% under planned activity for births. ENHT are reporting a reduction in bookings with community midwives, which is the subject of further review. There has been an increase in charges related to non-elective activity ( 276k movement compared to month 9), outpatient activity ( 165k movement) and Insulin Pumps ( 72k movement). Non-elective activity was 6% over plan in month 10 and 9% higher than the same period in Specifically, there was a high level of non-elective activity in General Surgery (31% over plan in month 10) and General Medicine (37% over plan). An adjustment continues to be made to non-elective charges following the outcome of mediation. Outpatient activity saw a significant increase in month 10 compared to the previous month, with an increase of 1,082 (14.5%) new appointments compared to December 2016, 2,992 (22.7%) follow up appointments and 415 (9.3%) increase in procedures. Key specialties that over performed in terms of outpatient activity month 10 were trauma and orthopaedics, ENT, and diagnostic imaging (specifically in MRI and Ultrasound). Insulin Pumps also saw a significant increase in month 10. This may partially be due to a catch up in invoicing. However, there are other work streams related to insulin pump provision currently being undertaken with ENHT to understand current pathways and processes. The Lister Primary Care Service (LPCS) commenced on 31 January 2017, which is designed to stream patients who are appropriate based on their clinical needs, to alternative services such as primary care and ambulatory care, and to reduce the number of A&E attendances. From 31 st January to 5 th March 487 patients have been seen through the LPCS, with the pilot due to run until the end of March 2017, following which a formal evaluation to inform future commissioning decisions will be undertaken. Princess Alexandra Hospital (PAH) At month 10, the CCG is reporting an overspend of 145k against straight line plan, after making a number of adjustments to the M10 flex SLAM report received. 7

8 A&E tariff activity remains c. 3% under plan, while the volume of locally priced streamed away attendances continues to exceed plan by 20%. The Flex report indicates that non elective tariff activity in total is significantly under plan (17%). One of the drivers for this is the large number of patients being seen, treated and discharged from ED, rather than admitted as a NEL same day or short stay. PAH conversion rate to admission is currently at 17% compared to a national average of 22%. The most significant issue with PAH concerns maternity antenatal pathway charges. PAH included a charge of 1.7m in the month 10 report, which the CCG has formally disputed because this service was commissioned from ENHT and ENHT is billing the CCG accordingly. The CCG s stance is that ENHT should report and bill all antenatal pathway charges, with PAH recharging ENHT for any antenatal activity carried out. The CCG is facilitating discussions between both trusts to agree cross-charging arrangements for , and is reviewing the future commissioning of maternity pathways. There is no financial risk to the CCG as only one pathway price will be paid per patient. The CCG are in discussions with PAH to agree a year end forecast outturn position; there are currently two items for escalation, Maternity pathway billing and un-coded activity. Royal Free Foundation Trust The year to date position is an overspend of 605k. The main areas of overspend trust wide are Out Patients ( 292k), Patient Transport ( 198k), and Non-Elective (emergency) excess bed days ( 162k). The biggest overspends in Out Patients are first attendances at 193k, including cardiology ( 63k), geriatric medicine ( 35k) and paediatrics ( 24k), and Diagnostic Imaging at 78k. Patient Transport (PTS) is currently overspending by 198k. This is due to the activity staying with the Royal Free Hospital PTS provider rather than moving to Medical Services (MSL), as originally predicted. Non-Elective excess bed day expenditure includes 6 spells of more than 50 excess bed days costing 150k, of which 2 ( 86k) are for over 170 excess bed days. There remains one long stay critical care patient and one other long stay patient under investigation. Discussions are being held with the Trust about agreeing a year end position Activity The following charts show activity from April 2014 to January

9 In December the CCG saw a big drop in outpatient attendances across all localities within the CCG. However, in January we have seen levels rise back to the November position, which is considerably higher than previous years for this period and this is having a knock on effect with electives. Elective activity is virtually following the same trend line as outpatient referrals which is expected. There has been a significant rise in January, a level much higher than previous years for all localities. 9

10 A&E has seen a reduction in activity for January. Most localities have seen a decline apart from WelwynHatield and Lower Lee Valley which have seen a slight increase. For the last two months the monthly position has been back to previous year s levels for the same period. In January most of the localities saw a reduction in admissions apart from North Herts where there was a slight increase in admissions, (58). 10

11 3.5 Commissioning Non Acute COMMISSIONING - NON ACUTE POSITION AS AT 31st JANUARY 2017 Description Annual budget budget Actual FOT Previous month extrapolated Movement MH/LD Contracts and NCAs 77,831 64,859 62,745 2,114 2,486 2, IAPT 4,402 3,669 3, (66) Hertfordshire Community Trust 40,464 33,720 33, (51) Community Services excl HCT 6,028 5,023 4, (26) Continuing Healthcare & FNC 30,150 25,303 27,313 (2,010) (2,397) (1,932) (78) Intermediate Care 3,191 2,659 2, (42) 70 Better Care Fund 17,564 14,637 14, (0) Hospices 3,425 2,854 2, (1) NHS Property Services Ltd 2,039 1, ,334 1, Prior year balance 0 0 (1,179) 1,179 1,179 1,179 0 Other Non Acute 10,240 8,150 7, TOTAL 195, , ,769 3,804 4,258 3, Continuing healthcare spend remains to be the main area of concern. At Month 10 the CCG is showing an overspend of 2,010k, forecast to 2,397k by the year end. This is a deterioration on last month when the forecast overspend was 2,241k. Mental Health continues to underspend, a year to date underspend of c 2.1m and a forecast underspend of c 2.5m, which is very much in line with last month s position. As reported last month, this relates to funding currently uncommitted or where no calls have been made against reserves, a forecast underspend due to slippage on mental health investment, and an underspend on learning disability independent placements and section 117 services. 3.6 Commissioning Primary Care COMMISSIONING - PRIMARY CARE Description Annual budget budget Actual FOT Previous month extrapolated Movement GP Prescribed Drugs 79,688 66,771 67,160 (390) (465) 81 (471) Central Drugs 2,452 2,043 1, (1) Oxygen Scriptswitch (0) Local Enhanced Services 1,378 1,148 1,267 (119) (129) (103) (16) Primary Care IT 1,496 1,247 1,247 (0) 0 (0) (0) Out of Hours 4,545 3,787 3,806 (19) (25) (17) (2) Commissioning Framework 5,945 4,953 3,607 1,346 1,515 1,344 2 Acute in hours visiting service 1,529 1,274 1, per patient (18) TOTAL 98,644 82,566 81,350 1,216 1,186 1,714 (498) 11

12 The prescribing figures are based on the April to December figures issued by the Business Services Authority. The forecast outturn position has significantly changed since last month, the position is now an overspend of 465k compared to last month when we were showing a forecast underspend of 97k. The underspend on the commissioning framework mainly relates to the over 75 health checks. 3.7 Forecast The forecast year-end position is an underspend of 14,698 which is made up of the required underspend of 7,743k, which we have always reported to achieve and the 1% Transformation reserve of 6,955k. 3.8 Balance Sheet Cash The table below shows the total amount of cash utilised compared with the amount that would be expected if the annual amount, referred to as maximum cash drawdown (MCD) was spent equally throughout the year. The MCD is calculated as the CCG s allocation adjusted for non-cash items (depreciation), the planned underspend, and the opening cash bank balance. Cumulative year to 000's Cash Drawn from NHSE 521,200 CHC retrospective payment 1,066 Drugs recharges 66,272 Home oxygen recharges 633 Total cash drawings 589,170 Cash book position 630 Total cash utilised 589,800 Maximum cash annual drawdown 710,467 Cash Phasing Equal 1/12ths 592,056 Disproportionate Usage (2,256) ( ) indicates less cash drawn than expected) This shows that we have spent 2.3m less than 10/12 of the annual MCD and remained within our cash draw-down limits Balance sheet as at 31 st January 2017 The following table shows the movement in the balance sheet between the end of March 2016 and end of January

13 Closing balance 31 March 2016 Closing balance January 2017 ytd movement Non-current Assets Property, Plant & Equipment 1,422 2, Current Assets Debtors 2, (1,786) Pre-payments 3,452 5,777 2,325 Cash & Cash Equivalents 259 (630) (889) Total Assets 7,322 7, Current Liabilities Trade & Other Payables: (45,994) (47,352) (1,358) Provisions (837) (275) 561 Total Current Liabilities (46,830) (47,628) (797) Total Assets Employed (39,508) (39,824) (316) Financed by Taxpayers Equity General Fund 39,508 39, of which: Cash drawings & top-slice (589,170) Expenditure 589,487 Total Taxpayers Equity 39,508 39, Debtors The table below shows an analysis of the debtors figure in the balance sheet, by length of time since the raising of invoices. 000 Current 102 Overdue 1-30 days 55 Overdue days 170 Overdue days 0 Overdue days 0 Overdue days 38 Overdue days 39 Overdue 361+ days 0 Total due amount 404 AR overdue 91+ amount days % of total 19.2% 4. RISKS/MITIGATION MEASURES The main areas of uncertainty are the final outturn postions for acute Trusts and prescribing. Year end positions have to be agreed with NHS Trusts and these are currently being negotiated. Prescribing spend will be estimated from the April to January reported BSA spend. 13

14 The forecast break even position assumes full use of the contingency reserve so there is no further scope to use that reserve to mitigate the risk. However, the risks are not considered to be significant and we are confident that the control total will be achieved. 5. RECOMMENDATIONS To note the report and associated risks. 6. NEXT STEPS To agree year end positions with Trusts. Alan Pond Chief Finance Officer March

15 APPENDIX 1 EAST & NORTH HERTS CCG ACUTE REPORT MONTH 10 Description Contracts Local Trusts Annual budget budget Actual Forecast East & North Herts 206, , ,479 (9,156) (10,240) Princess Alexandra 57,161 47,634 47,779 (145) (193) Royal Free 25,635 21,362 21,967 (605) (726) Independent Sector 23,381 19,484 20,841 (1,357) (1,628) Cambridge University Hospitals 11,394 9,495 9, West Herts Hospitals 2,717 2,264 2, Luton & Dunstable 1, ,164 (167) (200) Other Trusts UCLH 7,954 6,628 7,178 (550) (648) North Middlesex 7,239 6,033 6,648 (616) (739) Moorfields 3,774 3,145 3,337 (192) (231) Royal National Orthopaedic 3,465 2,888 2, Barts Health 2,838 2,365 2, Royal Brompton & Harefield 1,474 1,228 1,234 (5) (6) Papworth 1,309 1,091 1,226 (136) (163) Mid Essex 1,556 1,297 1,296 0 Guys & St Thomas 1,416 1,180 1,187 (7) (9) Imperial College (197) (237) North West London (129) (155) Great Ormond Street Basildon & Thurrock BHR University Hospital (333) (399) Chelsea and Westminster Kings Bedford (61) (73) Whittington (21) (25) East of England Ambulance & PTS 19,945 16,621 17,330 (709) (851) Other Acute Non Contract Activity (NCAs) 4,669 3,891 4,010 (119) (143) IVF 1, Cheshunt MIU (98) (117) Services Outside Contracts (4) (12) IFRs Reserves 1,860 1,566 1,566 1,860 Prior year balance (3,225) 3,225 3,225 TOTAL 393, , ,952 (9,125) (10,881) 15

16 APPENDIX 2 (page 1 of 2) This Month - January 2017 North Herts Lower Lea Valley Stevenage Welwyn Hatfield 000's 000's 000's 000's Summary Budget Actual Budget Actual Varian ce Budget Actual Budget Actual Acute Services Tariff related 1st Outpatient attendances 3,237 3, ,211 2,324 (113) 2,736 2, ,163 3,271 (108) Follow-up outpatient attendances 3,476 3,720 (244) 2,655 2, ,901 3,107 (206) 3,313 3,654 (341) Outpatient procedures 1,976 2,440 (464) 1,203 1,240 (37) 1,523 1,884 (361) 1,627 2,126 (499) Elective admissions 10,481 11,412 (931) 7,569 8,386 (817) 8,892 9,255 (363) 9,820 10,760 (940) Non-elective admissions 15,602 15,971 (369) 8,827 9,252 (425) 11,980 12,762 (782) 14,442 14,976 (534) Non contract activity (NCAs) (11) (33) (111) Discharge Summary Credit A&E 3,019 3,033 (14) 1,925 1, ,018 2, ,435 3,781 (345) Maternity 3,976 4,198 (223) 3,042 2, ,117 4,146 (29) 4,477 4, Urgent Care Centres 1 1 (0) (52) 2 2 (0) 0 2 (2) Market Forces Factor (pro rata to pbr) 6,008 6,312 (304) 5,282 5,297 (15) 5,276 5,362 (86) 6,002 6,382 (380) Threshold (595) (620) 25 (337) (359) 22 (496) (495) (0) (551) (581) 30 Readmissions (407) (394) (13) (230) (228) (2) (339) (315) (24) (377) (370) (7) Tariff adjustment for ENHT Total tariff-related 47,473 49,978 (2,504) 33,181 34,013 (833) 40,093 41,900 (1,807) 46,183 49,343 (3,161) Non tariff-related 12,102 10,892 1,210 8,372 9,105 (733) 9,881 9,913 (31) 12,051 11, CQUIN 1,420 1,486 (66) 1,059 1,079 (20) 1,204 1,227 (23) 1,345 1,434 (88) Ambulance & Patient Transport 3,326 3,470 (145) 2,231 2,328 (97) 2,699 2,817 (117) 3,172 3,310 (138) IVF Reserves Further savings required/ funding available Sub-total Acute 64,939 65,998 (1,059) 45,256 46,641 (1,384) 54,373 55,995 (1,623) 63,337 65,456 (2,119) Non-acute commissioning MH/LD Contracts and NCAs 13,291 12, ,883 8, ,615 10, ,602 12, IAPT and Counselling (81) Community Services excl HCT* HCT 7,996 7, ,799 4, ,478 5, ,351 6,394 (44) NHS Continuing Healthcare 4,966 5,378 (412) 3,319 3,594 (275) 3,966 4,295 (329) 4,709 5,099 (391) Intermediate Care Palliative care Hospices (32) (21) (26) (30) AQP Vasectomy AQP Ophthalmology (was Herts Eye) Other Non Acute Better Care Fund Sub-total Non Acute 29,396 28, ,420 18, ,827 22, ,866 26, Primary Care Commissioning GP prescribed drugs 13,645 14,186 (542) 8,082 8, ,652 10,957 (305) 12,939 12, Central Drugs Scriptswitch & Medicines Management Oxygen (6) (5) Out of hours (4) (3) (3) (4) GP IT Enhanced Services - incl Nursing Homes (86) (17) (25) (17) Acute In Hours Visiting per head > 75s , per head Sub-total Primary Care 16,788 17,079 (291) 9,910 9, ,971 13,033 (62) 15,741 15, Running Costs Contingency / (further Savings Plans required) Winter Pressures Funding Transformation reserve MH reserve Investment Funding/Quality Premium Contingency Total Allocation - all items within the scope 111, , ,063 75,235 (172) 90,748 91,299 (551) 106, ,068 (439) 16

17 APPENDIX 2 (page 2 of 2) This Month - January 2017 Upper Lea Valley Stort Valley & Villages Reserve & Unattrib incl 000's 0.00% 000's E&NCCG Total Summary Budget Actual Budget Actual Budget Actual Budget Actual Acute Services Tariff related 1st Outpatient attendances 3,604 3,778 (175) 1,786 1,842 (56) ,814 17,207 (393) Follow-up outpatient attendances 3,795 4,082 (287) 1,871 1,977 (106) ,036 19,206 (1,170) Outpatient procedures 2,005 2,375 (370) 1,057 1, (8) 9,404 11,116 (1,711) Elective admissions 11,918 13,269 (1,351) 6,074 6,222 (148) ,929 59,431 (4,502) Non-elective admissions 13,646 14,155 (509) 6,240 6,407 (167) 1,108 1, ,845 74,590 (2,745) Non contract activity (NCAs) (25) (32) 3,891 4,010 (119) Discharge Summary Credit A&E 2,845 3,003 (158) 1,245 1,275 (29) (58) 15,832 16,364 (531) Maternity 4,317 4, ,859 1,889 (30) ,861 21, Urgent Care Centres (35) 2 3 (1) (4) (95) Market Forces Factor (pro rata to pbr) 6,404 6,819 (415) 3,044 3,171 (127) (3) 32,252 33,581 (1,329) Threshold (501) (549) 49 (222) (249) 26 (45) (41) (3) (2,745) (2,894) 149 Readmissions (343) (349) 7 (152) (158) 6 (27) (26) (0) (1,875) (1,841) (34) Tariff adjustment for ENHT (0) 0 0 (0) 0 Total tariff-related 48,648 51,601 (2,953) 23,256 23,886 (630) 2,030 1, , ,704 (11,841) Non tariff-related 11,487 10,331 1,156 4,834 4, ,318 1,711 (393) 60,046 57,894 2,152 CQUIN 1,422 1,526 (103) (26) (3) 7,189 7,518 (329) Ambulance & Patient Transport 3,254 3,396 (142) 1,569 1,637 (68) (2) 16,289 16,998 (709) IVF Reserves (569) 0 (569) 1, ,566 Further savings required/ funding available Sub-total Acute 65,417 67,021 (1,604) 30,629 31,043 (414) 2,879 3,798 (919) 326, ,952 (9,122) Non-acute commissioning MH/LD Contracts and NCAs 13,029 12, ,313 6, ,866 62,745 2,121 IAPT and Counselling (25) ,662 3, Community Services excl HCT* ,022 2,946 2,076 HCT 5,813 5, ,284 3,347 (63) (0) 0 (0) 33,720 33, NHS ,409 1, Continuing Healthcare 4,868 5,272 (404) 2,359 2,554 (196) 1,116 1,120 (4) 25,303 27,313 (2,010) Intermediate Care ,659 2, Palliative care Hospices (31) (15) 5 6 (0) 2,618 2,775 (156) AQP Vasectomy (3) AQP Ophthalmology (was Herts Eye) Other Non Acute ,141 6, ,420 6, Better Care Fund ,637 14, ,637 14, Sub-total Non Acute 27,109 26, ,907 13, ,048 22, , ,769 3,804 Primary Care Commissioning GP prescribed drugs 13,303 13,307 (4) 6,539 6,730 (191) 1,610 1, ,771 67,160 (390) Central Drugs (28) 2,043 1, Scriptswitch & Medicines Management Oxygen (2) Out of hours (4) (2) 8 8 (0) 3,787 3,806 (19) GP IT ,247 1,247 (0) 1,247 1,247 (0) Enhanced Services - incl Nursing Homes (43) (11) ,148 1,267 (119) Acute In Hours Visiting ,274 1, per head > 75s 1, (0) 4 (4) 4,953 3,609 1,344 1 per head (7) Sub-total Primary Care 16,235 15, ,962 7,999 (36) 2,958 2, ,566 81,352 1,214 Running Costs ,205 9, ,378 9, Contingency / (further Savings Plans required) , ,540 Winter Pressures Funding ,806 3, ,806 3, Transformation reserve MH reserve Investment Funding/Quality Premium Contingency Total Allocation - all items within the scope 109, ,568 (102) 52,842 52, ,898 41,760 1, , ,487 (0) 17